Clinics in Orthopedic Surgery最新文献

Background: This study aimed to compare the rates of blood transfusion and blood loss after hip arthroplasty using patient blood management (PBM). In addition, we investigated the occurrence of hypophosphatemia after injection of iron supplement with intravenous ferric carboxymaltose.

Methods: Between March 2022 and February 2023, 233 patients underwent total hip arthroplasty or hemiarthroplasty with the application of PBM, including 95 men and 138 women with a mean age at the time of index operation of 62.7 years (range, 21-100 years). A control group of 466 patients treated between 2010 and 2019 was identified based on propensity score matching (1 : 2) including matching for age ± 3 years, sex, and diagnosis (disease or fracture). We compared changes in hemoglobin (Hb) levels, transfusion rate, blood loss, and prevalence of hypophosphatemia before and after the PBM protocol.

Results: The PBM group had a significantly lower intraoperative blood loss (mean, 116 mL vs. 268 mL, p < 0.001) and transfusion rate (15% vs. 41%, p < 0.001) than the control group. Preoperative mean Hb level was 13.23 g/dL for the PBM group and 12.64 g/dL for the control group. Postoperative day 2 mean Hb level in the PBM group was significantly higer than that of the control group (12.37 ± 1.82 g/dL vs. 9.87 ± 1.44 g/dL, p < 0.001). The preoperative incidence of hypophosphatemia was 3.5% and increased to 23% postoperatively. Two weeks after surgery, the incidence of hypophosphatemia decreased to 7.1%, and there were no complications due to hypophosphatemia during hospitalization.

Conclusions: This study demonstrated that the PBM program for hip joint arthroplasty reduced the rates of blood transfusion and blood loss. Therefore, PBM may be positively associated with improved clinical outcomes.

Background: Femoral neck fracture is a rare condition among fractures in the pediatric population. However, its potential for grave complications such as avascular necrosis or severe limb length discrepancy warrants prompt diagnosis and management. Much effort has been made to assess fracture risk in young adolescents in relation to obesity, low vitamin D levels, or young age osteoporosis. However, to our knowledge, there has been no literature that highlights a higher incidence of femoral neck fracture in adolescents with low body mass index (BMI).

Methods: At a level I trauma center, 22 early adolescents aged 10 years and older who had femoral neck fractures and underwent surgical treatment were included in the study. At the time of injury, BMI of each patient was stratified into 5 categories (underweight, normal weight, overweight, moderate obesity, and extreme obesity) based on BMI for age. Underweight was defined as a BMI below the 5th percentile, normal weight as between the 5th and 85th percentile, overweight as between the 85th and 95th percentile, and obese as above the 95th percentile. Then the patients were divided into 2 groups according to trauma degree: high-energy trauma and low-energy trauma. Low-energy fractures were defined as those caused by all types of trauma except for accidents involving motor vehicles, bicycles, or ski and all falls from greater than standing height. Independent samples t-tests and Pearson's chi-square tests were conducted between the 2 trauma groups.

Results: Excluding 2 patients lost to follow-up, 4 of 13 patients (30.77%) in the low-energy fracture group were underweight, whereas none in the high-energy fracture group were underweight. Including valgus impacted femoral neck fractures, 7 femoral neck fractures were nondisplaced, while 13 were complicated with displacement and required closed reduction. Avascular necrosis was observed in 4 cases and limb length discrepancy in 3 cases. The mean BMI percentile differed statistically significantly between the 2 trauma groups (p < 0.05).

Conclusions: Low-energy femoral neck fractures in adolescents appeared to be associated with low BMI. Future studies are required to clarify the relationship between low BMI and fracture risk.

[This corrects the article on p. 460 in vol. 17, PMID: 40454124.].

Sutures and suture anchors are commonly used in rotator cuff repairs as they offer cost-effective and mechanically robust solutions for tendon-bone interface (TBI) healing. However, in large to massive rotator cuff tears, where substantial tendon loss and limited intrinsic healing potential are present, conventional repair techniques alone often fail to restore the native biomechanics and structural integrity. Consequently, retear rates in these cases remain unacceptably high. This review summarizes recent advances in graft-based augmentation strategies aimed at improving outcomes in these challenging clinical scenarios. Furthermore, we propose a novel biomaterial that can be easily shaped, promotes endogenous cell activity throughout tendon regeneration, and offers sufficient mechanical support to the TBI.

Background: This study aimed to document the epidemiology of revision total knee arthroplasty following periprosthetic joint infection (RTKA-f-PJI) in Korea between 2011 and 2019 and analyze the economic burden of RTKA-f-PJI.

Methods: Epidemiological data on RTKA-f-PJI in Korea between 2011 and 2019 were obtained from the Korean Health Insurance Review and Assessment database. The annual numbers and growth rates of entire RTKAs and RTKA-f-PJIs and the RTKA-f-PJI rate (RTKA-f-PJI / entire RTKAs) were determined. Subgroup analyses were performed according to sex and age. TKA failure was categorized into early and late failures, and RTKA-f-PJI rates were compared between the groups. The total and mean personal costs for each year were compared between the RTKA-f-PJI and RTKA-f-non-PJI groups.

Results: Between 2011 and 2019, the total growth rate of RTKA-f-PJI was 57.6%, and the RTKA-f-PJI rate was maintained at approximately 30%. The RTKA-f-PJI rate was higher in males than in females. The number of RTKA-f-PJIs markedly increased in patients aged 70-79 years and ≥ 80 years. The RTKA-f-PJI rates for early and late failures were 45% and 24.8%, respectively. The total cost of RTKA-f-PJI increased from $15,757,308 in 2011 to $19,606,594 in 2019. The mean personal cost of RTKA-f-PJI was more than 4 times higher than that of RTKA-f-non-PJI.

Conclusions: The number and socioeconomic costs of RTKA-f-PJIs increased significantly in Korea between 2011 and 2019. Given that RTKA-f-PJI is a complex procedure associated with higher complication rates and unsatisfactory functional outcomes, continuous efforts to reduce the incidence of PJI after TKA are necessary.

Background: Posttraumatic osteoarthritis (OA) is one of the complications of distal radius fractures (DRFs). Involvement of the sigmoid notch (SN) is a risk factor, but there are few studies that support this. In this study, we hypothesized that SN involvement can affect the radiological and clinical outcomes of surgically treated DRFs and that there would be differences based on the degree of SN involvement.

Methods: The authors reviewed patients who underwent surgical treatment for DRF at our institution and were followed up for over 5 years. The patients were divided into 2 groups based on SN involvement. All patients underwent postoperative plain radiographs at the last follow-up to evaluate posttraumatic OA at the distal radioulnar joint (DRUJ). On computed tomography (CT) scans of the SN involvement group, articular step-off and gap distance were measured. Posttraumatic OA was graded using the Knirk and Jupiter radiographic criteria. For clinical evaluation, grip strength, wrist range of motion, pain visual analog scale score, Disabilities of the Arm, Shoulder, and Hand questionnaires, and Modified Mayo Wrist Score were assessed.

Results: Radiologically, the DRUJ OA grades were significantly higher in the SN involvement group. The step-off and gap distance measured on CT scans revealed no significant correlation with the grades. Clinical outcomes were not significantly different between the 2 groups.

Conclusions: SN involvement did not affect clinical outcomes in DRF patients with a minimum of 5 years of follow-up. However, radiologically, the OA grades were significantly higher in the SN involvement group. Therefore, in cases of DRF with SN involvement, there is no significant difference in clinical outcome, but it is necessary to explain to patients that posttraumatic DRUJ arthritis may occur in the future.

Intimate knowledge of local anatomy is required, especially in the biportal endoscopic approach due to its minimally invasive nature. Conditions such as aberrant anatomy, advanced degeneration, and deformities can make endoscopic lumbar decompression more challenging. The computed tomography (CT)-based surgical navigation system is employed with the biportal endoscopic technique to manage lumbar compressive pathologies. The CT-based navigation system offers clear advantages in precision, allowing for careful decompression without excessive bony work, thus preventing instability and reducing the chance of wrong-level surgery. We describe the general steps, indications, advantages, surgical tips, limitations, and ways to avoid complications. In conclusion, the use of CT-based navigation for biportal endoscopic lumbar decompression is an effective and precise strategy, particularly in more complex cases with challenging anatomy, multilevel pathologies, or significant anatomical variations.

Background: This study aimed to compare the clinical outcomes of arthroscopic reduction and percutaneous fixation with those of open reduction and internal fixation for intra-articular epiphyseal ankle fractures.

Methods: We conducted a retrospective review of consecutive patients who underwent intra-articular epiphyseal ankle surgery between 2016 and 2021. A total of 88 patients were included and divided into 2 groups: the arthroscopic reduction group (AS group) and the conventional open reduction group (OR group). Fifteen patients were allocated to the AS group, and 30 were selected from the OR group using propensity score matching in a 1 : 2 ratio, considering demographics, fracture configuration, and follow-up period. The clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), while radiological evaluations were used to assess bone union and the congruence of the articular surface. We also analyzed complications such as infection, nonunion, angulation, leg length discrepancy, and posttraumatic osteoarthritis.

Results: There was a significant difference in follow-up periods between the groups in terms of demographics (p = 0.04); however, successful propensity score matching eliminated any differences in demographic and fracture configuration variables between the groups (all p > 0.05). The etiology of trauma was similar across other variables (p > 0.05). Postoperative FAOS ranged from good to excellent in both groups, with no significant differences between them (all p > 0.05). Both groups achieved bone union without nonunion, with no significant differences in bone union time or joint congruency (all p > 0.05). Although there were more complications in the OR group than in the AS group (3 vs. 0 cases), this difference was not statistically significant (p = 0.083).

Conclusions: Arthroscopic reduction and percutaneous fixation appear to be effective, minimally invasive options for the treatment of intra-articular epiphyseal ankle fractures, offering outcomes comparable to open reduction with a low rate of complications.

Backgroud: Proper sizing of the coracoid is an important factor when using the Latarjet procedure. However, several studies have reported that the Asian coracoid may not be large enough for the Latarjet. A distal clavicle has recently been suggested as a locally available osteoarticular graft for restoring glenoid bone loss. The objective of this study was to examine the anatomic morphometry of the coracoid and distal clavicle in the Korean population.

Methods: A total of 66 cadaveric coracoids and clavicles (32 men and 34 women) underwent continuous 1.0-mm slice computed tomography (CT) scans. CT images were imported into Mimics software for reconstruction of a 3-dimensional model of the coracoid process and clavicle. The length, width, and height of the coracoid process were measured. In addition, the width and height within 10 mm of the lateral end of the clavicle were also measured. Analysis of correlation between measured parameters and demographics data was performed.

Results: The mean length of the coracoid was 19.2 ± 2.0 mm, the width of the coracoid was 15.5 ± 1.7 mm, and the height of the coracoid was 11.5 ± 1.6 mm. The width and height of the 10 mm point of the clavicle were 22.1 ± 3.7 mm and 12.0 ± 1.8 mm, respectively. The results showed that women had smaller measurements than men in all parameters (p < 0.05). Height showed a significant positive correlation with all measured parameters (p < 0.05). An equation for estimating the coracoid length using these findings was as follows: coracoid length (mm) = 11.70 + (0.041 height) + 1.86 (the last number was added for men); the width at the 10 mm point of the clavicle = 0.16 × height + 3.18 (the last number was added for men).

Conclusions: The morphologies of the coracoid process and the distal clavicle showed significant correlations with sex and height. The coracoid length tends to be smaller in Asians than Caucasians, thus, the distal clavicle might be a suitable option for reconstruction of instability-related glenoid bone loss in the Asian population.

Background: The microfracture technique, a first-line treatment for full-thickness cartilage defects (FTCDs), involves perforation of the subchondral bone to allow bone marrow, including mesenchymal stem cells, to promote healing. However, microfracture often fails within 5 years due to the insufficient durability of fibrous cartilage and subchondral bone deterioration. To address this issue, augmenting bone marrow stimulation (BMS) with several systemic or local agents has been explored. This study evaluated the effects of irisin (IR) and bevacizumab (BEVA), individually and combined, as alternative intra-articular BMS augmentation methods compared with hyaluronic acid (HA) and platelet-rich plasma (PRP).

Methods: Forty-eight Wistar albino male rats were divided into 6 groups (n = 8 per group): control, PRP, HA, BEVA, IR, and BEVA-IR. An FTCD was created, followed by BMS in the control group. PRP, HA, and IR were injected intra-articularly on the day of surgery, with BEVA administered in the fourth postoperative week. All rats were sacrificed at 12 weeks. Distal femurs were analyzed via micro-computed tomography (micro-CT), and cartilage regeneration was assessed macroscopically and histologically using the International Cartilage Repair Society (ICRS) and Pineda scores, respectively.

Results: The Pineda score was significantly lower in the BEVA-IR group compared with the control (p < 0.001), PRP (p < 0.05), HA (p < 0.05), and BEVA (p < 0.05) groups. Significant differences in ICRS stages were observed between the control group and both the IR (p < 0.05) and BEVA-IR (p < 0.01) groups, as well as between BEVA and BEVA-IR (p < 0.01). Micro-CT analysis revealed that the defect width was significantly lower in the PRP (p < 0.05), IR (p < 0.05), and BEVA-IR (p < 0.01) groups compared with the control group. The defect depth in the BEVA-IR group was significantly lower compared with the control (p < 0.01), PRP (p < 0.05), BEVA (p < 0.01), and HA (p < 0.05) groups. The IR group also showed a significantly smaller defect area compared with the BEVA (p < 0.01) and HA (p < 0.05) groups.

Conclusions: To the best of our knowledge, this study is the first to investigate intra-articular IR in FTCDs. The IR and BEVA-IR groups, particularly the BEVA-IR group, demonstrated superior outcomes in all evaluations. These findings suggest that combining BEVA and IR has synergistic effects on cartilage healing in FTCDs.